Inequalities in primary care management of knee pain and disability in older adults: an observational cohort study

• Published in: Rheumatology (Oxford, England) Vol. 50; no. 10; pp. 1869 - 1878
• Main Authors: Jinks, Clare, Vohora, Kanchan, Young, Julie, Handy, June, Porcheret, Mark, Jordan, Kelvin P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2011
• Subjects: Aged; Biological and medical sciences; Clinical Science; Cohort Studies; Disability Evaluation; Disabled Persons; Diseases of the osteoarticular system; Female; Health Services Accessibility - statistics & numerical data; Humans; Knee Joint - physiopathology; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Osteoarthritis; Osteoarthritis, Knee - epidemiology; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - therapy; Outcome Assessment, Health Care; Pain - epidemiology; Pain - physiopathology; Pain Management; Pain Measurement; Patient Acceptance of Health Care; Primary Health Care - statistics & numerical data; Socioeconomic Factors; United Kingdom - epidemiology; United Kingdom; Knee pain; Access to care; Knee osteoarthritis; Referral; Inequalities; Socio-economic factors; Medical records; Primary care; Human; Knee; Diseases of the osteoarticular system; Rheumatology; Care; Disability; Pain; Socioeconomic factor; Cohort study; Arthropathy; Adult; Degenerative disease; Medical record; Osteoarthritis; Inequality
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/ker179

Objectives. To describe primary care management of knee pain, in relation to National Institute for Health and Clinical Excellence (NICE) OA guidelines, and examine variation in management by patient characteristics. Methods. Subjects were 755 adults aged 50 years who responded to baseline and 3-year surveys and had consulted primary care for knee pain. Medical records (1997-2006) were searched. Associations of having interventions from the outer circle (adjunctive treatments or Step 3) of the NICE guidelines with self-reported socio-demographic and knee-specific factors were determined. Results. Eighty per cent had received a Step 3 intervention. Thirty-eight per cent had been referred to secondary care, and 10% had received a knee replacement. Forty-three per cent had been prescribed an opioid and 41% an NSAID. Severe knee pain or disability at baseline and follow-up was the main association with receiving a Step 3 intervention [adjusted odds ratio (OR) 2.26; 95% CI 1.38, 3.70] and with referral (OR 2.57; 95% CI 1.72, 3.83). Older patients were less likely to be referred. Although non-significant, those of higher social class, in more affluent areas, older age or overweight or obese, appeared more likely to receive a knee replacement. Fifty per cent of those reporting severe knee pain or disability in both surveys had not been referred to secondary care. Conclusion. Most of the older adults who consult primary care with knee pain receive at least one Step 3 intervention from the OA guidelines. Inequalities in the management and referral of knee problems in primary care were generally not observed, although there were some trends towards differences in likelihood of total knee replacement.